Beca J, Butt W
Intensive Care Unit, Royal Children's Hospital, Melbourne, Australia.
Pediatrics. 1994 May;93(5):726-9.
To review demographic data and outcome of children who received extracorporeal membrane oxygenation (ECMO) for refractory septic shock.
Review of medical charts of nine children receiving ECMO for culture-proven refractory septic shock treated in a multidisciplinary pediatric intensive care unit.
Median age was 12 years and median weight was 45 kg. Median inotrope requirements (micrograms/kg per minute) before ECMO were dopamine, 15; dobutamine, 12.5; epinephrine, 4; and norepinephrine, 3.5. Four children received two inotropes concurrently, and five received three or more. All nine patients had severe respiratory failure; eight had evidence of other organ system dysfunction, with six having five or more organ system dysfunctions. Median PRISM score was 27. Median duration of ECMO was 137 hours. Within 24 hours of starting ECMO, 7 of 9 children had all inotropes stopped. Four patients died and five survived, all of whom are leading normal lives.
In this small group of children with probably fatal septic shock, ECMO was successfully supported the circulation and 5 of the 9 children survived. We suggest that septic shock should not be considered a contraindication to ECMO.
回顾因难治性感染性休克接受体外膜肺氧合（ECMO）治疗的儿童的人口统计学数据及治疗结果。
回顾在一家多学科儿科重症监护病房接受ECMO治疗的9名经培养证实为难治性感染性休克儿童的病历。
中位年龄为12岁，中位体重为45千克。ECMO治疗前血管活性药物的中位需求量（微克/千克每分钟）分别为：多巴胺15、多巴酚丁胺12.5、肾上腺素4、去甲肾上腺素3.5。4名儿童同时使用两种血管活性药物，5名儿童使用三种或更多种。所有9例患者均有严重呼吸衰竭；8例有其他器官系统功能障碍的证据，其中6例有五种或更多器官系统功能障碍。PRISM评分中位数为27。ECMO的中位持续时间为137小时。在开始ECMO治疗后的24小时内，9名儿童中有7名停用了所有血管活性药物。4例患者死亡，5例存活，所有存活患者均过着正常生活。
在这一小群可能致命的感染性休克儿童中，ECMO成功支持了循环，9名儿童中有5名存活。我们建议感染性休克不应被视为ECMO的禁忌证。
